{"id":467,"date":"2015-01-28T20:29:14","date_gmt":"2015-01-28T20:29:14","guid":{"rendered":"http:\/\/pr.humana.net.php53-11.ord1-1.websitetestlink.com.php53-18.ord1-1.websitetestlink.com\/?page_id=467"},"modified":"2021-06-17T13:25:36","modified_gmt":"2021-06-17T13:25:36","slug":"provider-tools","status":"publish","type":"page","link":"https:\/\/humana.pr\/en\/providers\/provider-tools\/?lang=en","title":{"rendered":"Provider Tools"},"content":{"rendered":"<div class=\"primary-block margin-btm-2\">\n<div class=\"clearfix\">\n<h1>Claims<\/h1>\n<p>At Humana, we are at the forefront of billing practices. We have procedures in place, such as electronic billing, to expedite the payment of your claims. If you rather file your claim on paper, you are welcome to do so, keeping in mind the following:<\/p>\n<ul class=\"bulleted\">\n<li>Use the universal CMS 1500 form. This applies to professional services, Labs, X-Rays and suppliers. You must fill out all the blanks in the form.<\/li>\n<li>Separate bills according to the product (Humana Health Plans, Humana Insurance, Medicare).<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>You may send your claims to the following addresses:<\/p>\n<div class=\"eight columns\"><strong>Commercial<\/strong><br \/>\nHumana Claims Department<br \/>\nPO Box 191920<br \/>\nSan Juan, PR 00919-1920<\/div>\n<div class=\"eight columns\"><strong>Medicare<\/strong><br \/>\nHumana Claims Department<br \/>\nPO Box 195560<br \/>\nSan Juan, PR 00919-5560<\/div>\n<\/div>\n<\/div>\n<section class=\"section-content-bottom-shadow x3\">\n<h3>Clearinghouse<\/h3>\n<p>You can also file your claim through the clearinghouse of your choice.\u00a0When sending your claim, use one of the following Humana identifiers:<\/p>\n<div class=\"eight columns\"><strong>Medicare Claims: <\/strong>61101<br \/>\n<strong>Medicare Visits: <\/strong>61101<\/div>\n<div class=\"eight columns\"><strong>Commercial Claims:<\/strong> 61101<\/div>\n<p>&nbsp;<\/p>\n<\/section>\n<section class=\"section-content-bottom-shadow x3\">\n<h3>Time limit to file a claim<\/h3>\n<p>Medicare Advantage: claims must be sent within one calendar year from the date the service was rendered.<\/p>\n<p>&nbsp;<\/p>\n<p>Commercial Plans: claims must be sent within the time limit stipulated in the provider\u2019s contract or as stipulated under applicable state law. Generally, these claims must be filed within a time period of:<\/p>\n<ul class=\"bulleted\">\n<li>Physicians: 120 days from the date of service<\/li>\n<li>Facilities: 180 days from the date of service or the date the patient was released<\/li>\n<li>Requests for Review: 180 days from the date of denial<\/li>\n<\/ul>\n<p>You can verify the status of your claims using our online tools.<\/p>\n<p><a href=\"https:\/\/www.humana.com\/provider\/medical-providers\/education\/claims\/\" target=\"_blank\" rel=\"noopener noreferrer\">Press here<\/a> to register or to access your account.<\/p>\n<\/section>\n<section class=\"section-content-bottom-shadow x3\">\n<h3>Referrals<\/h3>\n<p>You can file your electronic referrals using our online tools. Press <strong>Sign in or Register<\/strong>\u00a0to access your account. You can also file your referrals through:<\/p>\n<ul class=\"bulleted\">\n<li>Business and Medicare: Interactive Voice Response System (IVR): 1-800-611-1474<\/li>\n<li>Medicare: <a href=\"http:\/\/www.availity.com\" target=\"_blank\" rel=\"noopener noreferrer\">www.availity.com<\/a><\/li>\n<\/ul>\n<\/section>\n<section class=\"section-content-bottom-shadow x3\">\n<h3>Conexi\u00f3n Humana<\/h3>\n<p>We have redesigned our Conexi\u00f3n Humana Interactive Voice Response System, and optimized our technological tools in order to expedite procedures and deliver the best possible service.<\/p>\n<p>&nbsp;<\/p>\n<p>You can use our system to verify eligibility, co-payments for services offered by our providers, request ID Card duplicates, certifications, referrals, authorizations of coverage, notices of admission, and ancillary or out-patient services, among others.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>You can access the system by calling 1-800-611-1474 and following the provider&#8217;s menu options.<\/strong><\/p>\n<p><a href=\"http:\/\/humanapr.wpengine.com\/wp-content\/uploads\/2015\/02\/Flyer-Conexion-Humana-nuevo-IVR1.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Press here<\/a> to get instructions on how to request services through Humana.<\/p>\n<p><a href=\"http:\/\/humanapr.wpengine.com\/wp-content\/uploads\/2015\/01\/Lista-de-Proveedores-con-NPI-Comercial-Eng.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Press here<\/a> to get a list of providers with their Network Provider Identification (NPI).<\/p>\n<\/section>\n<section class=\"section-content-bottom-shadow x3\">\n<h3>ICD-10<\/h3>\n<p>The Centers for Medicare &amp; Medicaid Services (CMS) ordered the replacement of the entire set of diagnosis and procedure codes of the International Classification of Diseases 9th Edition\/Revision (ICD-9 in English, CIE-9 in Spanish) with those of the International Classification of Diseases 10th Edition\/Revision (ICD-10, CIE-10) Clinical Modification (CM).<\/p>\n<p><a href=\"https:\/\/www.humana.com\/provider\/medical-providers\/education\/claims\/icd-10\/questions\" target=\"_blank\" rel=\"noopener noreferrer\">Press this link to get more details about the ICD-10.<\/a><\/p>\n<\/section>\n<section class=\"section-content-bottom-shadow x3\">\n<h3>Updated information from Humana about the Health Reform and Claims Payment<\/h3>\n<p>The Health Insurance Portability and Accountability Act (HIPAA) requires a specific typification of transactions for claims sent electronically. These standards are used to help improve the quality of service to patients, and the processing of claims and data reports.<\/p>\n<p>&nbsp;<\/p>\n<p>Humana has received the Phase II Certification from the Committee on Operating Rules for Information Exchange (CORE). The CORE certification was awarded after completing all procedures for the Phase I and Phase II certifications. Obtaining the CORE Phase II Certification shows Humana\u2019s commitment to its health services providers regarding improved access to patient information about benefits or insurance eligibility, before or at the time services are rendered to patients. Additionally, all CORE operation norms support crucial security and privacy practices.<\/p>\n<p><a href=\"https:\/\/www.humana.com\/provider\/medical-providers\/education\/claims\/reform-roadmap\" target=\"_blank\" rel=\"noopener noreferrer\">Press this link to get more details about the Health Reform.<\/a><\/p>\n<\/section>\n<section class=\"section-content-bottom-shadow x3\">\n<h3>Prompt Payment Law and Health Insurance Code<\/h3>\n<p>Humana complies with all federal and state laws. To get information about your rights under the Health Insurance Code and the Prompt Payment Law, visit the Office of the Commissioner of Insurance of Puerto Rico webpage using the following link:<\/p>\n<p><a href=\"http:\/\/ocs.gobierno.pr\/ocspr\/index.php\/asuntos-legales\/codigos-de-seguro\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/ocs.gobierno.pr\/ocspr\/index.php\/asuntos-legales\/codigos-de-seguro<\/a><\/p>\n<\/section>\n<section class=\"section-content-bottom-shadow x3\">\n<h3>Consent for Sterilisation<\/h3>\n<p>The contract with the Puerto Rico Health Insurance Insurance Administration (ASES) for the 2017 Platinum Medicare Program and applicable Federal regulations (42 CFR part 50, subpart B) requires urologists and obstetricians to complete the form Of Consent for Sterilisation to all beneficiaries who are going to perform the sterilisation procedure.<\/p>\n<p><a href=\"http:\/\/humanapr.wpengine.com\/wp-content\/uploads\/2017\/01\/Consentimiento-para-la-esterilizacion.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Press here<\/a> To obtain the circular letter and documents for Consent of Sterilisation.<\/p>\n<\/section>","protected":false},"excerpt":{"rendered":"<p>Claims At Humana, we are at the forefront of billing practices. We have procedures in place, such as electronic billing, to expedite the payment of your claims. If you rather [&hellip;]<\/p>","protected":false},"author":1,"featured_media":0,"parent":15,"menu_order":144,"comment_status":"open","ping_status":"open","template":"template-pharmacy-tools.php","meta":{"_eb_attr":"","ngg_post_thumbnail":0,"footnotes":""},"class_list":["post-467","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/humana.pr\/en\/wp-json\/wp\/v2\/pages\/467","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/humana.pr\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/humana.pr\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/humana.pr\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/humana.pr\/en\/wp-json\/wp\/v2\/comments?post=467"}],"version-history":[{"count":0,"href":"https:\/\/humana.pr\/en\/wp-json\/wp\/v2\/pages\/467\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/humana.pr\/en\/wp-json\/wp\/v2\/pages\/15"}],"wp:attachment":[{"href":"https:\/\/humana.pr\/en\/wp-json\/wp\/v2\/media?parent=467"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}